Active NPI
Van Anh Mong Le, DDS
- Dentist
- Milwaukee, WI
National Provider Identifier
1295872893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4109
- Practice address
- 1555 S Layton Blvd
Milwaukee, WI 53215-1924 - Phone
- (414) 902-2366
- Fax
- (414) 385-6612
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4109 | WI | Primary |
Addresses
Primary practice location
1555 S Layton Blvd
Milwaukee, WI 53215-1924
Mailing address
9633 N Sunset LN
Mequon, WI 53092-5334
Phone (414) 902-2366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151209000622 | WI | Order and Referring Only - Oral Surgery | 0648571075 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4109 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379894400000",
"number": "1295872893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9633 N SUNSET LN",
"city": "MEQUON",
"state": "WI",
"postal_code": "530925334",
"telephone_number": "414-902-2366",
"fax_number": "414-385-6612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 S LAYTON BLVD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532151924",
"telephone_number": "414-902-2366",
"fax_number": "414-385-6612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LE",
"first_name": "VAN ANH",
"middle_name": "MONG",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2013-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "4109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.